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Post intensive care

Ankita Shukla, Christine Sonnie, Sarah Worley, Amit Sharma, Dawn Howard, Jon Moore, Ricardo J Rodriguez, George Hoppe, Jonathan E Sears
Importance: The Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial (SUPPORT) demonstrated that static low oxygen saturation decreased retinopathy of prematurity (ROP) but increased mortality compared with static high oxygen saturation cohorts. Objective: To compare outcomes of a biphasic oxygen protocol with static targets recommended by SUPPORT. Design, Setting, and Participants: Retrospective cohort study comparing biphasic vs static standards 41 months prior to and 42 months after a change from biphasic to static SUPPORT standards at a level III neonatal intensive care unit (Fairview Hospital, Cleveland, Ohio)...
February 14, 2019: JAMA Ophthalmology
Sarah Grace Buttle, Brigitte Lemyre, Erick Sell, Stephanie Redpath, Srinivas Bulusu, Richard J Webster, Daniela Pohl
BACKGROUND/OBJECTIVE: Seizure monitoring via amplitude-integrated EEG is standard of care in many neonatal intensive care units; however, conventional EEG is the gold standard for seizure detection. We compared the diagnostic yield of amplitude-integrated EEG interpreted at the bedside, amplitude-integrated EEG interpreted by an expert, and conventional EEG. METHODS: Neonates requiring seizure monitoring received amplitude-integrated EEG and conventional EEG in parallel...
February 14, 2019: Journal of Child Neurology
Mehmet Akif Yazar, Mehmet Barış Açıkgöz, Adnan Bayram
Background/aim: Some of the patients suffering from cardiac arrest (CA) remain in a chronic unconscious state in intensive care units (ICUs). The primary aim of this study was to evaluate the efficacy of chest compression (CC) on cerebral oxygenation during cardiopulmonary resuscitation (CPR). As a secondary goal, we attempted to determine the effects of regional cerebral oxygen saturation (rSO2) values on consciousness and the survival rate using the Full Outline of Unresponsiveness (FOUR) scoring method...
February 11, 2019: Turkish Journal of Medical Sciences
Sansanee Aungsataporn, Chadakarn Phaloprakarn, Siriwan Tangjitgamol
AIM: To identify the rate and associated factors of loss to post-partum follow-up among adolescent mothers. METHODS: A matched case-control study was conducted among Thai adolescents who gave birth between January 2011 and December 2016 and were scheduled for a 6-week post-partum visit. Cases (n = 568) included mothers who did not return for follow-up whereas controls (n = 568) were mothers who attended a post-partum visit. Cases were matched with controls according to age group and date of delivery...
February 13, 2019: Journal of Obstetrics and Gynaecology Research
Mai Kimura, Takashi Kohno, Takashi Kawakami, Masaharu Kataoka, Takahiro Hiraide, Hidenori Moriyama, Sarasa Isobe, Toshimitsu Tsugu, Yuji Itabashi, Mitsushige Murata, Shinsuke Yuasa, Keiichi Fukuda
BACKGROUND: There is no consensus on the length of hospital stay (LOHS) and post-interventional management after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We examined temporal trends with respect to LOHS and requirement for intensive care for BPA and their relationship with the incidence of BPA-related complications. METHODS: From November 2012 to September 2017, a total of 123 consecutive patients with CTEPH who underwent BPA were enrolled (age: 66...
February 2019: Canadian Journal of Cardiology
Michael R Nahouraii, Colleen H Karvetski, Rita A Brintzenhoff, Gaurav Sachdev, Susan L Evans, Toan T Huynh
Multiprofessional rounds (MPR) represent a mechanism for the coordination of care in critically ill patients. Herein, we examined the impact of MPR on ventilator days (Vent-day), ICU length of stay (LOS), hospital LOS (HLOS), and mortality. A team developed guidelines for MPR, which began in February 2016. Patients admitted between November 2015 and March 2017 with Acute Physiology and Chronic Health Evaluation (APACHE) IV and injury severity scores were included. Outcome data consisted of Vent-day, Vent-day observed/expected ratio (O/E), ICU LOS, ICU LOS O/E, HLOS, HLOS-O/E, and mortality...
January 1, 2019: American Surgeon
Giovanna Brandi, Nino Stocchetti, Alberto Pagnamenta, Federica Stretti, Peter Steiger, Stephanie Klinzing
BACKGROUND: Hyperventilation-induced hypocapnia (HV) reduces elevated intracranial pressure (ICP), a dangerous and potentially fatal complication of traumatic brain injury (TBI). HV decreases the arteriolar diameter of intracranial vessels, raising the risk of cerebral ischemia. The aim of this study was to characterize the effects of moderate short-term HV in patients with severe TBI by using concomitant monitoring of cerebral metabolism, brain tissue oxygen tension (PbrO2 ), and cerebral hemodynamics with transcranial color-coded duplex sonography (TCCD)...
February 13, 2019: Critical Care: the Official Journal of the Critical Care Forum
Sonia Ruiz-Bustillo, Consol Ivern, Neus Badosa, Nuria Farre, Esther Marco, Jordi Bruguera, Mercè Cladellas, Cristina Enjuanes, Miguel Cainzos-Achirica, Julio Marti-Almor, Josep Comin-Colet
BACKGROUND AND AIMS: Lack of achievement of secondary prevention objectives in patients with ischaemic heart disease remains an unmet need in this patient population. We aimed at evaluating the six-month efficacy of an intensive lipid-lowering intervention, coordinated by nurses and implemented after hospital discharge, in patients hospitalized for an ischaemic heart disease event. METHODS: Randomized controlled trial, in which a nurse-led intervention including periodic follow-up, serial lipid level controls, and subsequent optimization of lipid-lowering therapy, if appropriate, was compared with standard of care alone in terms of serum lipid-level control at six months after discharge...
February 13, 2019: European Journal of Cardiovascular Nursing
Michael J Loftus, Michelle K Yong, Scott Wilson, Anton Y Peleg
We report a case of fatal disseminated varicella zoster virus (VZV) with delayed-onset rash in a 66-year-old female more than two years following uncomplicated deceased donor renal transplantation. Whilst on a stable regimen of maintenance immunosuppression, the patient presented with chest and abdominal pain with concomitant hepatitis and pancreatitis. After pursuing multiple other potential causes of her symptoms, the correct diagnosis of VZV was only suspected after the development of a widespread vesicular rash - 11 days after her initial symptoms...
February 12, 2019: Transplant Infectious Disease: An Official Journal of the Transplantation Society
N Beghdadi, A Soprani, A Kraemer, P Bucur, C Barrat, L Genser
BACKGROUND: Severe post-operative malnutrition (SM) is a dreaded complication after gastric bypass often related to the short bowel syndrome consecutive limb length mismeasurement or intestinal resections. Patients with rapid weight loss or malnutrition can experience liver failure with cirrhosis and require liver transplantation (LT). Malnutrition can constitute a contraindication to LT since it negatively impacts on postoperative morbidity. RYGB reversal is an effective option to consider when nutritional support has failed...
February 11, 2019: Obesity Surgery
Michelle T Vo, Connie S Uratsu, Karen R Estacio, Andrea Altschuler, Eileen Kim, Stacey E Alexeeff, Alyce S Adams, Julie A Schmittdiel, Michele Heisler, Richard W Grant
BACKGROUND: Most patients with diabetes do not meet all evidence-based goals of care, and many patients report poor communication and lack of involvement in decision-making during primary care visits. OBJECTIVE: To test the hypothesis that a "Pre-Visit Prioritization" secure email message could improve visit communication and glycemic control among patients with type 2 diabetes. DESIGN: We conducted a pragmatic, provider-randomized, multi-site clinical trial from March 2015 to October 2016 across 30 primary care practices within Kaiser Permanente Northern California (KPNC), a large integrated care delivery system...
February 11, 2019: Journal of General Internal Medicine
Yihu Tang, Yanhu Wu, Jinfu Zhu, Xiang Liu, Jinxin Zhou, Haobing Huang, Mingke Li, Yawei Dai, Xu Han
Background: We previously reported the techniques for total endoscopic atrial septal defect (ASD) repair on hearts arrested with cardioplegia through three small incisions in the chest wall without aid of a surgical robotic system. The optimal results motivated us to use total thoracoscopic technology for ASD on perfused beating hearts. Methods: From 2010 to 2017, 161 patients with a mean age of 28.31±12.34 years who underwent non-robotically assisted total thoracoscopic closure for ASD were included in this study, and those patients were also divided into two groups, including group A and group B...
December 2018: Journal of Thoracic Disease
Sachin Talwar, Abhishek Anand, Bharat Siddarth, Sivasubramanian Ramakrishnan, Shiv Kumar Choudhary, Balram Airan
Objective: We compared the pre- and post-operative right ventricular (RV) function by tricuspid annular plane systolic excursion (TAPSE) between trans-right atrial (t-RA) versus t-RA/RV (RA/RV) approach for the repair of Tetralogy of Fallot (TOF). Patients and Methods: Fifty consecutive patients, 1-15 years of age, undergoing intracardiac repair of TOF between September 2015 and June 2016 were randomized into two groups based on the approach for repair as follows: t-RA or t-RA/RV approach...
January 2019: Annals of Pediatric Cardiology
Harish Chellani, Pratima Mittal, Sugandha Arya
Health facilities in India are faced with the challenge of providing quality newborn care in the face of major skilled human resource shortage. A possible solution is the concept of Mother-Neonatal ICU (M-NICU), where the mother has her bed inside the neonatal intensive care unit (NICU) by the side of baby's warmer. Our observations in M-NICU of a public sector hospital in New Delhi, India, indicate that mothers can be easily trained to follow asepsis routines and monitor the neonates, and are better prepared for their post-discharge care...
December 15, 2018: Indian Pediatrics
R Grotelüschen, W Bergmann, M N Welte, M Reeh, J R Izbicki, K Bachmann
BACKGROUND: Acute mesenteric ischemia (AMI) is associated with a mortality of 60-80%. Early diagnosis and rapid treatment have a decisive influence on therapy. The aim of this study was to evaluate the prognostic value of AMI markers on mortality, in order to better anticipate the clinical course and to initiate therapeutic steps at an early stage. STUDY DESIGN: An analysis from our prospective database of 302 consecutive patients with AMI who were treated surgically in the Department of General Surgery between February 2003 and October 2014 was performed...
February 8, 2019: Journal of Visceral Surgery
Peijin Esther Monica Fan, Siok Bee Tan, Gillan Irani Farah, Poh Gek Cheok, Wan Ting Chock, Wasudevan Sutha, Donghui Xu, Weiyan Chua, Xiu Ling Kwan, Chi Ling Li, Wei Qin Teo, Shin Yuh Ang
BACKGROUND: Distance from the tip of the nose to earlobe to xiphisternum is commonly used to determine the length of nasogastric tube to be inserted. However, it is not evidence-based and frequently leads to improper positioning. OBJECTIVES: This study evaluated four formulae and the distance from the tip of the nose to earlobe to xiphisternum in estimating the internal length of nasogastric tube required for optimal positioning. DESIGN: Observational Study...
January 14, 2019: International Journal of Nursing Studies
Robert M Rossi, Eric Hall, Emily A DeFranco
OBJECTIVE: In 2014, the Society for Maternal-Fetal Medicine, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists published an executive summary of a joint workshop to establish obstetric interventions to be considered for periviable births. We sought to evaluate changes in practice patterns since the publication of these guidelines. METHODS: We conducted a population-based cohort study of all singleton live births delivered between 22 0/7 and 23 6/7 weeks of gestation in the United States within two time epochs: pre-executive summary (Epoch 1: 2012-2013) and post-executive summary (Epoch 2: 2015-2016) guideline release...
February 4, 2019: Obstetrics and Gynecology
Bianca D Arney, Stacey A Senter, Avital C Schwartz, Taylor Meily, Stacy Pelekhaty
BACKGROUND: Adequate nutrition is linked to improved patient outcomes during critical illness. Nutrition care is further enhanced by registered dietitian nutritionist (RDN) order-writing privileges, which improve the implementation of nutrition interventions. The purpose of this performance improvement project was to evaluate the effect of RDN order-writing privileges on enteral nutrition (EN) order compliance and nutrition delivery in selected intensive care units (ICUs) at a university-affiliated teaching hospital...
February 11, 2019: Nutrition in Clinical Practice
Athanasios Chalkias, Eleni Arnaoutoglou, Theodoros Xanthos
Resuscitation guidelines remain uniform across all cardiac arrest patients, focusing on the delivery of chest compressions to a standardized rate and depth and algorithmic vasopressor dosing. However, individualizing resuscitation to the appropriate hemodynamic and ventilatory goals rather than a standard "one-size-fits-all" treatment seems a promising new therapeutic strategy. In this article, we present a new physiology-guided treatment strategy to titrate the resuscitation efforts to patient's physiologic response after cardiac arrest...
February 11, 2019: Heart Failure Reviews
Huei-Wen Lim, Isaiah P Schuster, Ramona Rajapakse, Farah Monzur, Sundas Khan, Keith Sultan
Background/Aims: : Optimal management of inflammatory bowel disease (IBD) with concomitant Clostridium difficile infection (CDI) is controversial, especially when CDI diagnosis is made by polymerase chain reaction (PCR) testing, which may reflect colonization without infection. Methods: We performed a multicenter review of all inpatients with IBD and PCR diagnosed CDI. Outcomes included length of stay, 30- and 90-day readmission, colectomy during admission and within 3 months, intensive care unit (ICU) admission, CDI relapse and death for patients who received CS after CDI diagnosis versus those that did not...
February 12, 2019: Intestinal Research
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